Hospital doors under pressure; policies and trends in the major tertiary care hospital in Albania

Objectives. Quantification of elective and emergency hospital admissions as a resultant of patients’ diagnostic and therapeutic pathways (referral system) and patients’ preferences to choose the health-care provider.
Design. Retrospective analysis of routine hospital discharge data. Findings were analyzed with descriptive statistical methods. Setting. University Hospital Center, “Mother Teresa”, Albania, a secondary and tertiary health care provider to the capital Tirana and tertiary health care provider for the rest of Albania.
Subjects. 692,284 hospital admissions during eleven years period, 2006-2016. Main outcome measures. Hospital admission trends measured as Average Annual Percentage Change and standardized admissions by district per 100,000 inhabitants.
Results. Number of hospital admissions increased from 55,528 in the baseline year to 78,130 in the last year of our study. During eleven years ALOS changed from 7.60 to 5.80 days and BOR increased from 83.2% to 91.6%. AAPC total, Average Annual Percentage
Change was 3.2% at the ending year, 2006 to 2016. Cramér's V between variables ‘year of admission’ and ‘prefecture’ was 0.024, p < 0.001 and between ‘year of admission’ and ‘Tirana University Hospital Center administrative units’ was 0.055, p < 0.001. Both relationships are weak but significant. Maps show the exaggerated flow from other districts towards Tirana.
Conclusions. Patient satisfaction, as a health care quality metric, is a driving force towards the choice of health provider. The satisfied patient chooses again or tells the next patient the preferred provider. The perceived professional difference among health care
providers has built a competitive environment. The referral system puts strict rules over patient pathway which in his turn finds ways to bypass it if preferences are not taken in consideration. Commitment to such rules is accepted till forces considered as expression
of free choice overcome them, jeopardizing the performance of the whole system. Patient’s preferences deserve to be evaluated and incorporated in the patient pathway design.